PROJECT SUMMARY/ ABSTRACT This F32 fellowship award will provide Dr. Erica Farrand with the support necessary to accomplish the following goals: (1) to become an expert in patient-oriented clinical research in idiopathic pulmonary fibrosis (IPF); (2) to develop a unique skill set in collecting, analyzing and interpreting real-world data; (3) to gain advanced skills in epidemiology, biostatistics and data science methods to conduct clinical research; (4) to advance the IPF field by improving our understanding of the clinical impact of acute exacerbation of IPF. To achieve these goals, Dr. Farrand will conduct clinical investigations in two distinct healthcare systems, the University of California San Francisco (UCSF) Health and Kaiser Permanente Northern California (KPNC). IPF is a progressive fibrotic lung disease associated with high morbidity and mortality and over $1 billion in healthcare cost annually. Acute exacerbation of IPF, is an acute respiratory deterioration and arguably the most clinically significant event in the natural history of the disease. The fundamental aim of this NRSA proposal is to leverage the electronic health records of UCSF Health and KPNC to generate real-world evidence regarding the epidemiology of acute exacerbation of IPF, the nature and variability of its clinical management and health care utilization across settings, and the impact of common management strategies on clinical outcomes. Research in this fellowship will utilize electronic health record data to define the acute exacerbation population using a case-validated diagnostic algorithm (Aim 1), document the scope and impact of acute exacerbation on clinical practice and healthcare resource utilization, comparing the UCSF and KPNC systems (Aim 2), and determine the association of common management approaches with hospital based and short-term patient-outcomes (Aim 3). This project will demonstrate the power of leveraging high-quality electronic health record data to both advance our understanding of a clinical condition and document the association of treatment interventions with patient and system level outcomes